A nurse manager is implementing a quality improvement project to reduce the number of methicillin-resistant Staphylococcus aureus (MRSA) infections at the facility. Which of the following actions should the nurse manager take first?

A. Schedule the meeting to occur in the nursing station: Conducting the meeting in the nursing station may not provide the privacy and confidentiality needed for a sensitive discussion about performance issues. A private setting is essential to encourage open communication and a constructive dialogue.

B. Arrange seating to sit across from the nurse: Sitting across from the nurse can create a confrontational atmosphere. It is more effective to arrange seating in a way that fosters collaboration and openness, such as sitting beside the nurse, which can help reduce tension during the conversation.

C. Tell the nurse they need to improve their client care delivery: Directly stating that the nurse needs to improve without first exploring their perspective may be perceived as accusatory and could lead to defensiveness. A more supportive approach is necessary to promote constructive feedback and development.

D. Ask the nurse how things have been going since the last meeting: This action is the most appropriate as it opens the conversation in a non-confrontational manner, allowing the nurse to express their thoughts and experiences. It fosters a supportive environment and encourages the nurse to reflect on their performance and any challenges they may be facing, leading to a more productive appraisal.

Near miss:

• Incident Report 1: The nurse identified the client's allergy before administering azithromycin, preventing an adverse reaction. Holding the medication and notifying the provider ensured patient safety, making this a near miss rather than an adverse event.

Adverse Event:

• Incident Report 2: The client did not receive prescribed prophylactic antibiotics during labor, leading to neonatal sepsis. The lack of antibiotic administration increased the risk of serious complications, making this an adverse event with potential long-term consequences.

• Incident Report 3: A tenfold dosing error led to the administration of 60 units instead of 6 units of insulin, resulting in severe hypoglycemia and unresponsiveness. This critical medication error placed the client at significant risk for neurological damage or death, classifying it as an adverse event.

• Incident Report 4: A critically low platelet value was reported but not communicated to the provider, delaying intervention and leading to a coma. The failure to act on critical lab results contributed to a preventable deterioration in the client’s condition, making this an adverse event.

• Incident Report 5: Despite being identified as a fall risk, the client sustained a fall due to a malfunctioning call bell, leading to an injury. The failure to address the defective equipment compromised patient safety, making this an adverse event that could have been prevented.